Does systemic thrombolysis improve outcomes compared to cardiac surgery in patients with left-sided prosthetic valve thrombosis without hemodynamic compromise?
Systemic thrombolysis, particularly using low-dose or slow-infusion protocols, may be the preferred option over surgery for managing left-sided prosthetic valve thrombosis without cardiogenic shock.
BACKGROUND: The optimal strategy in prosthetic heart valve thrombosis (PVT) remains controversial, with no randomized trials and conflicting observational data. We performed a systematic review and meta-analysis of evidence comparing systemic thrombolysis and cardiac surgery in PVT. METHODS AND RESULTS: =0.02, respectively). Treatment success, major bleeding, and stroke were similar between groups. Sensitivity analysis including studies that used low-dose or slow-infusion thrombolysis showed that the mortality rate was lower, and treatment success was higher, in patients referred to systemic thrombolysis, with similar rates of other secondary outcomes. CONCLUSIONS: There is evidence to suggest that thrombolysis might be the preferred option for the management of PVT without cardiogenic shock, pending future randomized controlled trials or larger observational studies.
Chopard et al. (Wed,) studied this question.